School Year	Springer’s LLC-Needville Waiver
SPRINGER’S LEARNING ACADEMY
Child’s Information

First & Last Name	Date of Birth	Age as of August 31, 2025

Street Address	City	State	Zip

Home Phone	School Name (25-26)	Grade (25-26)

Parent / Guardian(s) Information

First & Last Name   Mom  Dad  Guardian	E-mail Address

Street Address (if different than child’s)	City	State	Zip

Home Phone	Work Phone	Cell Phone

First & Last Name   Mom  Dad  Guardian	E-mail Address

Street Address (if different than child’s)	City	State		Zip	

Home Phone	Work Phone		Cell Phone		
Medical Information

Hospital Name	Hospital Address	Hospital Phone Number

Doctor Name	Doctor Address	Doctor Phone Number

List any known allergies and/or medical conditions we should know about

School Year	Springer’s LLC-Needville Waiver

Participation Information

(
(CHECK ALL THAT APPLY)
	 LITTLE SMARTIES PRESCHOOL ACADEMY
	 BEFORE/AFTER SCHOOL PROGRAM
	 DAY CAMPS AND/OR HOLIDAY CAMPS
	 SUMMER CAMPS
My Child is a member of Springer’s LLC- Needville Camp licensed by Texas Department of Family and Protective Services Little Smarties Preschool Academy, Before or After School Program, Day Camps & Holiday Day Camp and/or Summer Camp.
Pricing

5% transaction fee added to ALL online debit/credit card payments & e-check payments.

(Effective September 2020)
ANNUAL REGISTRATION FEE:		$75.00/year	      FAMILY REGISTRATION FEE:	$100.00/year		 BEFORE/AFTER SCHOOL PROGRAM	 $65/week		
LITTLE SMARTIES PRESCHOOL ACADEMY	Visit our website at www.springerslearningacademy.com
SPRINGER’S SUMMER CAMP PROGRAM	Visit our website at www.springerslearningacademy.com
Transportation
	 YES 	 NO MY CHILD WILL BE RIDING THE NISD BUS TO SCHOOL IN THE MORNINGS.
	 YES 	 NO MY CHILD WILL BE RIDING THE NISD BUS TO SPRINGERS IN THE AFTERNOON.

I, 	 (Parent/Guardian) request the personnel of Springer’s LLC- Needville to seek whatever medical care is necessary and advisable should an emergency arise, which would require treatment for my child. I understand that Springer’s LLC- Needville, as well as any staff member or coach, is not responsible for providing insurance for the above child enrolled and participating at Springer’s LLC- Needville Learning Academy and/or Springer’s Summer Camp. I agree to provide adequate accident and medical insurance for the above child. I agree to assume full financial responsibility for any injury that may occur due to the participation in activities at Springer’s LLC- Needville and on this property. I hereby release Springer’s LLC- Needville and Creekside Christian Fellowship, and all Springer’s LLC- Needville employees from any claims, liabilities of whatsoever nature, individually and collectively that may arise.

Parent/Guardian Print Name	Parent/Guardian Signature	Date
**All waivers attached MUST be read and signed to participate in activities at Springer’s LLC- Needville **
Photo Release Waiver
I hereby authorize Springer’s LLC- Needville, to publish the photographs and videos taken of me and/or the undersigned minor children, and our names, for use in the printed publications, website, and training purposes. I release Springer’s LLC- Needville from any expectation of confidentiality for the undersigned minor children and myself and attest that I am the parent or legal guardian of the children listed below and that I have the authority to authorize the use of their photographs, videos, and names. I acknowledge that since participation in publications and websites produced by Springer’s LLC- Needville is voluntary, neither the minor children nor I will receive financial compensation. I further agree that participation in any publication and website produced Springer’s LLC- Needville confers no rights of ownership whatsoever. I release Springer’s LLC- Needville, its contractors, and its employees from

School Year	Springer’s LLC-Needville Waiver
liability for any claims by me or any third party in connection with my participation or the participation of the undersigned minor children.

Waiver of Liability for Ninja, Preschool Gymnastic, Tumbling Academy Field Trips
	(INITIAL) In consideration of participation in Gymnastics/Ninja Zone/Tumbling, I represent that I understand the nature of this Activity and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I acknowledge that if I believe conditions are unsafe, I will immediately discontinue participation in the Activity. I fully understand that this Activity (Ninja Zone, tumbling, and/or Gymnastics) and the usage of the equipment skills are practiced on during the activities involves risks of serious bodily injury, including permanent disability, paralysis, and death, which may be caused by my own actions, or inactions, those of others participation in the event, the conditions in which the event takes place, or the negligence of the “releases” named below. I fully accept and assume all such risks and all responsibility for losses, cost, and damages I incur as a result of my participation in the Activity and/or on the equipment used in Springer’s LLC- Needville, I hereby release, discharge, and covenant not to sue respective administrators, directors, agents, officers, volunteers, employees, other participants, sponsors, advertisers and, if applicable, owners and lessors of premises on which the Activity take place (each considered one of the RELEASEES herein), from all liability, claims, demands, losses, or damages on my account caused in whole or in part by the negligence of the “releases” or otherwise, including negligent rescue operations and future agree that if, despite this release, waiver of liability, and assumption of risk I, or anyone on my behalf, makes a claim against any of the Releases, I will indemnify, save, and hold harmless each of the Releases from any loss, liability, damage, or cost, which any may incur as the result of such claim
	(INITIAL) I understand that Springer’s LLC- Needville, as well as any Springer’s LLC- Needville employee or coach, is not responsible for providing insurance for the child enrolled and participating in Springer’s LLC- Needville Learning Academy or Springer’s Summer Camp. I agree to provide adequate accident and medical insurance for the below child. I agree to assume full financial responsibility for any injury that may occur due to the participation in activities at Springer’s LLC- Needville and on this property.
	(INITIAL) I have read the Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect.

Waiver of Liability – Ninja Warrior Equipment and Warped Wall

My child, 	, has permission to participate on the warped wall and all Ninja Real Life equipment at Springer’s LLC- Needville during Springer’s Learning Academy ninja, preschool gymnastic, and/or tumbling field trips. I understand the risk and danger of allowing my child to participate on the Ninja Warped Wall and Real Life Ninja equipment. I hereby release, discharge, and covenant not to sue Springer’s LLC- Needville, Springer’s Summer Camp, Creekside Christian Fellowship or Ninja Zone, its respective administrators, directors, agents, officers, volunteers, employees, other participants, sponsors, advertisers and, if applicable, owners and lessors of premises on which the Activity takes place (each considered one of the RELEASEES herein), from all liability, claims, demands, losses, or damages on my account caused in whole or in part by the negligence of the “releases” or otherwise including negligent rescue operations and future agree that if, despite this release, waiver of liability, and assumption of risk I, or anyone on my behalf, makes a claim against any of the Releases, I will indemnify, save, and hold harmless each of the Releases from any loss, liability, damage, or cost, which any may incur as the result of such claim.

Parent/Guardian Print Name	Parent/Guardian Signature	Date